Armed Forces Personnel and Veterans Health Joint Group’s Implementation Group minutes: January 2021

Attendees and apologies

Name	Organisation	Attending / Deputy / Apologies
Jason Leitch	National Clinical Director (Chair)	Attended
Neil Morrison	Veterans Scotland – Health representative	Attended
Ian Cumming	Third sector representative: Erskine	Attended
Andrew Carter	NHS Borders Armed Forces and Veterans Champion	Attended
Mairi McKinley	NHS Fife Armed Forces and Veterans Champion	Attended
Claire Wood	NHS Highland Armed Forces and Veterans Champion	Apologies
Craig Cunningham	NHS Lanarkshire Armed Forces and Veterans Champion	Apologies
Sharon Callaghan	Regional Clinical Directors Operations Manager, MOD	Attended
Martin Bell	NHS Champion, NHS National Services Scotland	Attended
Lucy Abraham	Scottish Veterans Care Network	Attended
Katie Hislop	Armed Forces and Veterans Healthcare policy team, Scottish Government (Secretariat)	Attended
Michael Ross	Armed Forces and Veterans Healthcare policy team, Scottish Government (Secretariat)	Attended
Ruth Jays	Unit Head, Person Centred Healthcare and Participation Unit, Scottish Government	Attended
Annalena Winslow	Armed Forces and Veterans Healthcare policy team, Scottish Government	Apologies
Shaun Cauvin	Veterans Scotland	Apologies
Amanda Cronin	Improvement Advisor, Scottish Government	Attended
Maura Lynch	Mental Health, Scottish Government	Attended
Lorimer Mackenzie	Mental Health, Scottish Government	Attended

Items and actions

1. Welcome, introductions and apologies

Jason Leitch, Chair, welcomed members to the meeting. As a new member of the group, Andrew Carter, Director of Workforce at NHS Borders, introduced himself. Andrew has taken over the role of NHS Borders Armed Forces and Veterans Champion.

2. COVID-19 & Winter Season – Reflections on the impact

As the group had last met in November 2020, Jason invited reflections from members on the impact of COVID-19 over the last two months. Ian Cumming opened by sharing his perspective from the frontline in Erskine care homes. Residents have lost their lives, which has been difficult for staff and volunteers who know the residents well. The pandemic has also had a significant financial impact on the organisation, with additional spend in response to the pandemic going beyond budget, lack of fundraising opportunities, and lack of access to legacy income.

Ian reported that staff have been receiving COVID-19 vaccinations, with around 98% now vaccinated, and that there had been no reticence from staff in receiving the vaccine. He reflected that Erskine’s delivery has had to adapt in response to the pandemic, with their events centre going online.

Neil Morrison said that most of Veteran Scotland’s member organisations have also faced financial difficulty, with lack of charitable income being the central issue for Third Sector organisation. Neil raised this issue, alongside the central role of the Third Sector, at a recent Parliamentary Cross-Party Working Group. Without action, the services offered by the Third Sector are at risk of being reduced or lost altogether. Jason acknowledged the fundraising issue and said that this would be kept on the agenda with Ministers, and asked whether there was anything the SG could do to help. Neil suggested that raising visibility and awareness would be most helpful, and Jason suggested that sharing images of the Army at vaccination centres may be useful.

Neil also referred to Veteran Scotland’s December 2020 report on the very positive work that has been happening across the Third Sector.

Members of the group noted some positive aspects in changing work practices, with accessibility extended to some individuals who may not otherwise engage, reductions in operation costs through online delivery, and an increased geographic reach. It was felt that, moving forward, some of this learning could be retained and hybrid models of delivery (online and face-to-face) could help sustain the positive aspects.

Lucy Abraham added that there is a lack of evidence base on the effectiveness of  online therapy, but it is currently ongoing out of necessity. She is aware of disadvantages of online therapy, such as limitations on confidentially when household members are nearby. The situation has been reactive, but it does offer an opportunity for insight into which people and conditions online therapy works well for. Lucy reported that Veterans First Point (V1P) has had less foot-fall as a result of current restrictions, but that the caseload is high and, additionally, partner organisations have been less able to support them.

Ian discussed the negative impact on staff resourcing, in the context that 20% of Erskine’s staff (approximately 200 of a 1000 staff) are volunteers. Some volunteers are at risk and therefore cannot go to the centres, which results in greater workload for full-time staff. Jason added that this impact on staff has been shared in other spheres, such as Community Pharmacy. Erskine is currently undergoing a review by the Care Inspectorate, and Ian has made it clear within this review that the contribution of volunteers had been very significant.

Action: Secretariat to circulate a copy of Veteran Scotland’s Compendium of Health & Wellbeing Group Member Reports.

Action: Secretariat to contact SG Communications to access images of Armed Forces working on Vaccination rollout which may be shared with Neil.

3. Scottish Government Update

Jason reminded the group that, as well as progressing the 2020/21 priorities set by the Strategic Oversight Group (SOG), the 2019/20 priorities that had not been concluded due to prior work pressures were also being taken forward. He invited Katie Hislop to provide an update on progress towards 2019/20 and 2020/21 priorities.

Wheelchairs

Katie informed the group that a letter from Jason Leitch has gone out to all specialist services across Scotland. The letter requests that Wheelchair and Seating Services maintain and replace Ministry of Defence wheelchairs used by Armed Forces Personnel and Veterans to at least a level commensurate with that issued to them at the time of their discharge, provided it is safe and continues to meet their clinical and wheeled mobility needs.

In the future, work will be undertaken to assess the impact of this letter, similar to the work measuring the impact of the audiology communication.

In addition to the letter, there is a broader task of reviewing Scottish Government guidance on wheelchairs, in relation to all wheelchair users. Katie has engaged with the policy lead and reported that they are considering how best to take this forward.

In response, Jason questioned whether there is a need to escalate this issue, to effect progress.

Neil suggested that BLESMA would be a useful contact in taking forward such a review.

Action: Katie to discuss progression of the Scottish Government wheelchair guidance with policy colleagues

Action: Secretariat to initiate measuring impact of the letter to specialist services, at the right time.

Hearing Aids

Michael Ross informed the group that two surveys have been distributed to assess the impact of the letter, co-signed by Jason Leitch and Adrian Carragher, Head of Audiology at University Hospital Ayr, which was issued in August 2019. The letter encouraged the maintenance and like-for-like replacements of Ministry of Defence issued Hearing Aids.

One of the surveys is tailored for audiologists, and the other is for Armed Forces Personnel and Veterans. A further update can be provided at the April meeting when the survey results have been received and analysed.

Employability

Michael provided an update on work undertaken since the Implementation Group in November, where it was requested that a “task and finish” group was convened to discuss solutions to improving the advertising and promotion of NHS vacancies to veterans and those transitioning out of the services.

A group, with a breadth of experience and expertise, met on 13 January 2021, which brought about a detailed and engaging discussion. From the meeting, it was clear the issue extends beyond simply improving the rate at which jobs are advertised on veteran-centred websites, although this is a key aspect.

There were a series of wide-ranging actions from the meeting, such as: making links to promote the NHS as a post-service career through ongoing events; creating further career case studies; identifying barriers preventing job applications through a survey; supporting the sharing of best practice from an ongoing pilot once it is competed; and further thought is required on how to improve the visibility of Veteran-centred job websites amongst NHS Boards. These actions are being progressed and a further update can be provided at the April meeting.

The sub-group agreed to reconvene whenever their expertise could prove useful to the Implementation Group, which will be helpful in taking forward further related work.

Martin Bell added that he had upcoming meetings, with key partners such as CTP (Career Transition Partnership), to discuss a system of automating the process by which jobs are added from NHS job websites to Veteran-centred job websites.

Ian asked whether Social Care was covered during the meeting. Michael responded that the main focus was on the NHS, in acknowledgement of the Scottish Veterans Commissioner’s recommendation which focuses on Employment of veterans within the NHS. Consideration of Social Care may be taken into account moving forward.

Jason was pleased with this progress and thanked Michael for the update.

Identifying Veterans – NHS Fife Project

Amanda Cronin provided an update on the project which was discussed at the Implementation Group meeting in November. It involves working with a small cohort of GP surgeries using Quality Improvement methodology to trial the improved registration of veterans in GP surgeries via data coding on registration systems. Amanda and Katie presented to a cluster group of GPs recently, with a view to them identifying a small group of GP practices to work with. Many doctors were aware that they treated veterans and that they were not coded appropriately. When discussing the pilot with GPs, their opinion had been split, but this did not impede on the project as only a small number of practices were required for the project.

As NHS Fife Champion, Mairi McKinley has led on this work. She added that there will be a challenge to sell the process to some GPs in this cluster group, but they are hopeful that some will offer to be part of the project. Before taking such a decision, the group have asked for more detail of the advantages and benefits of the work. Jason agreed, noting that the learning from the pilot will be crucial in rolling out the process further.

Neil linked this work to Priority Treatment, which he described as requiring two central areas for improvement: continued professional development within hospitals and GP surgeries to increase awareness and clarifying veterans’ expectations on what Priority Treatment means.

Ian input that some veterans leave the Armed Forces on bad terms and may be reluctant to mention their veteran status. Such experiences should be taken into account, and it does not mean they do not deserve assistance.

Amanda added that the Ministry of Defence may have a role to play and a second strand of work examining areas, such as the transfer of medical records, may be worthwhile.

Neil discussed the possible value of a short module, possibly at Continuous Professional Development (CPD) level, in raising awareness of veterans’ issues within GP practices. He noted that it is important to remain within the context of the Covenant and its coverage of service-related injuries. In response, it was suggested that Laura Cox may be able to assist this work.

4. Scottish Veterans Care Network (SVCN)

Lucy updated that the SVCN launch took place in November. They had over one hundred delegates attend and very positive feedback from those involved. There has been great enthusiasm for the development of the network and the mental health action plan. They have launched their website and social media presence. A large range of stakeholders have volunteered to be involved in the Network’s governance. The first oversight board meeting has taken place. They are in the process of establishing voluntary positions so diverse voices can be heard. There has been understandable difficulty in gaining representation from medical staff due to the ongoing response to the COVID-19 pandemic and related work pressures. However they are keen to get involved in subsequent meetings as the network evolves.

5. Approach to the 2020/21 priorities on Mental Health and Priority Treatment

Jason outlined that priorities for 2020/21 are Employability, Priority Treatment (identifying veterans, access to services, and messaging) and Mental Health. While we have seen positive progress on employability and identifying veterans, we need to decide how to progress mental health and priority treatment messaging and access to services.

Mental Health

Lorimer Mackenzie provided an update on mental health. Veterans First Point (V1P) and Combat Stress have adapted their models of delivery during the COVID-19 pandemic. They are in an interim stage before work on the Mental Health Action Plan begins. It was suggested that, for this group, the Action Plan is the main area of work in the mental health sphere at the moment and that the best course of action is for this group to monitor how this progresses and for Mental Health colleagues to keep in touch. The group will be updated if the work is delayed due to COVID-19.

Lucy agreed and added that groups will be formed to develop the Mental Health Action Plan. SVCN holds overarching responsibility for the Action Plan.

Group members recognised the significant work pressures that mental health services are currently facing and the impact this has on mental health staff. Andrew suggested that Veteran groups may be able to provide support to the mental health workforce. In the past, veterans have been willing to engage in supportive roles. Lorimer added that this may be picked up by support hubs for NHS staff, while other members drew attention to existing support networks for specific workforce areas. Jason suggested that the NHS Champions could lead on this.

Action: Secretariat to explore the possibility of creating a Veteran forum for supporting mental health staff.

Priority Treatment

Neil drew attention to an upcoming meeting of the Priority Treatment Working Group. The focus of the group had shifted to a forum for sharing good practice amongst the four nation of the UK.

Neil added that Priority Treatment does not impact many people. Where it is required, it’s important for it applied correctly. He added that, due to the ongoing pandemic, he had heard about appointment cancellations for individuals and a lack of understanding throughout the health workforce on what Priority Treatment is.

There remains work on Priority Treatment messaging and communications. Katie reminded the group that we have been holding off work on messaging while the new UK Government legislation was being constructed, as it will be important to ensure that messaging aligns. However, we have become aware that the legislation will not cover priority treatment, which means we can proceed with work on messaging. Katie suggested that this work could involve learning from other parts of the Scottish Government, for example, pharmacy colleagues who regularly work on health messaging for pharmacies and GP surgeries. Neil said he is willing to be involved in this. Jason suggested he could offer support through, for example, a letter co-signed with the Scottish Veterans Commissioner. Communication teams could be involved to offer support on supplementary forms of communication, such as newsletters.

In the context of veteran’s access to services, Katie informed the group that SG performance management colleagues are constructing a clinical priorities framework. This work will include taking cognisance of protected characteristics and, while veteran status is not a protected characteristic, colleagues will take account of the principles of the covenant as they progress this work.

6. A.O.B.

Katie informed the group that NHS England had been in contact regarding their new Veterans Trauma Network and a meeting will take place in February. The primary aim will be to learn about the Network and to look at any potential lessons that could be put into a Scottish context. Ian has been asked about trauma hospitals, which he passed onto Erskine’s English counterparts.

Ian mentioned he had been informed that Poppy Scotland were considering producing a manifesto to flag priorities. In response to this, Ian and others had highlighted the work of this group in making progress on Armed Forces and Veterans’ health. Jason thanked them for highlighting the work of this group.

The next meeting will take place on Thursday, 29 April 2021.